Health and Human Services

Ban on gender-altering procedures for minors proposed

The Health and Human Services Committee heard six hours of often emotional testimony Feb. 8 on a bill that would ban gender-altering health care for minors in Nebraska.

Sen. Kathleen Kauth

LB574, introduced by Omaha Sen. Kathleen Kauth, would create the Let Them Grow Act, which would take effect on Oct. 1, 2023. The bill would prohibit physicians in Nebraska from performing or referring an individual for gender alteration procedures, including surgical procedures, hormone treatment and puberty blockers, if the individual is under the age of 19.

A physician who knowingly violates the bill’s provisions would be subject to review by the state’s medical licensing board. An individual who received a gender-altering procedure while under the age of 19, or their parent or guardian, could bring a civil action against the physician within two years of a procedure.

The distribution or use of state funds for any entity, organization or individual that provides gender-altering procedures to minors also would be prohibited under the bill’s provisions.

Kauth said she introduced LB574 to give children the necessary time to work through their feelings of gender dysphoria and any other complicating issues that may impact their gender perception.

“More than 85 percent of kids with gender dysphoria will desist if left alone in a process called ‘watchful waiting’,” she said. “These children need therapy to deal with the coexisting mental and emotional struggles they are experiencing — not irreversible, harmful and experimental medical procedures.”

In addition, Kauth referenced recent developments in countries that previously have been on the forefront of progressive LGBTQ+ policies. Kauth said Sweden and Finland — which previously offered comprehensive gender-alteration care — now prohibit the use of hormone therapy, puberty blockers and surgical procedures for anyone under the age of 18.

“We owe it to our children to pay attention to what these countries, who are decades ahead of us on this journey, are doing and why,” she said.

Supporters of the bill noted a lack of information regarding the long-term effects of hormone therapy and puberty blockers, and argued that minors are unable to appreciate the seriousness of irreversible medical decisions.

Jaime Dodge, a family practitioner in Nebraska, said several studies examining the relationship between gender-altering care and mental health failed to include a control group, leaving gaps in understanding the long-term consequences and effectiveness of various gender altering interventions.

Without this information, Dodge said, patients, families and clinicians are unable to make truly informed health care decisions.

“[LB574] would pause our current approach and allow us to fill in the gaps in our knowledge, focus care on social and emotional development and mental health and pursue further studies in the long-term effects of medical and surgical interventions,” Dodge said.

Also testifying in support of LB574 was Erin Brewer, who said she began to identify as male in the first grade after experiencing a sexual assault. Brewer said she would have done anything at that time to obtain puberty blockers or hormones, and that she believed transitioning then would have allowed her to dissociate and create a new person, detached from the trauma.

“If I had been medically transitioned, I wouldn’t have gotten the help I needed to work through my fear, self-hatred and shame,” Brewer said. “I never would have realized that my transgender identity was a coping mechanism.”

Angie Eberspacher, an early childhood educator, also spoke in support of the bill. According to the National Institute of Mental Health, she said, the area of the brain responsible for planning, prioritizing and controlling impulses is one of the last to develop.

“[The brain] does not finish developing and maturing until the mid to late twenties,” Eberspacher said. “Because these skills are still developing, teens are more likely to engage in risky behaviors without considering the potential results of their decisions.”

Marni Hodgen also testified in support of LB574, saying that Nebraska already has a number of laws in place to protect minors from potentially harmful actions.

“We don’t allow our children to drive until 16; we don’t allow them to purchase tobacco, get tattoos or vote until they’re 18 or buy alcohol until 21,” she said. “These laws protect children until they’re deemed an age mature enough to understand and handle responsibilities and consequences of partaking in certain actions.”

Opponents of the bill argued that medical decisions belong in the hands of families and medical professionals and emphasized the negative impact LB574 could have on the health and safety of transgender youth in Nebraska.

Testifying in opposition on behalf of the American College of Obstetricians and Gynecologists, Elizabeth Constance explained that studies examining gender-affirming care for children do not include a control group because doing so is considered medically unethical.

“Gender-affirming care is such established medicine at this point in time that no institutional review board will approve a research study for transgender kids that has a control group,” Constance said.

She added that some treatments, such as puberty blockers, are reversible and have not been shown to have any long-term negative health consequences.

Camie Nitzel, licensed psychologist and founder of Kindred Psychology, also testified in opposition, saying LB574 would be in direct conflict with the profession’s code of ethics.

“Gender-affirming care is recognized as best practice from both a medical and psychological perspective,” Nitzel said. “If I practice ethically according to the standards of my field then I will be practicing illegally according to the bill.”

Opponent Alek Duncan credited his access to gender-affirming health care at 16 for saving his life. When starting puberty, Duncan said he felt like his body had betrayed him. After spending early adolescence feeling “broken and disgusted” with himself, Duncan said his family found the help they needed.

“After trying basically anything else to prevent me from dying, my mom called a psychologist who was renowned for her gender and sexuality expertise,” Duncan said. “If I had not found her when I did, I know I would not have made it to 18.”

Also speaking in opposition to LB574 was Isabella Manhart. According to the U.S. Department of Health and Human Services, they said, early gender-affirming care is crucial to the overall health and well-being of transgender children.

Manhart also cited a study conducted by the Trevor Project, which found that 58 percent of transgender and nonbinary youth in Nebraska seriously considered attempting suicide in 2022.

“I’m not exaggerating when I say gender-affirming care saves lives,” they said. “The Journal of the American Medical Association reported that when trans kids received gender affirming care, odds of severe depression were lowered by 60 percent and odds of suicidality were lowered by 73 percent.”

The committee took no immediate action on LB574.

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